Association of Intracranial Pressure Monitoring on Postoperative Outcomes in Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Objective: This study aimed to evaluate the potential association of intracranial pressure (ICP) monitoring on postoperative outcomes among patients with spontaneous intracerebral haemorrhage (ICH). Methods: This study conducted a systematic review and meta-analysis of relevant literature retrieved across the Cochrane Library, Pubmed, Embase, and Web of Science from their inception to July 1, 2025. The primary efficacy outcome was unfavorable functional outcome (modified Rankin Scale 4–5 or Glasgow Outcome Scale 1–3). The primary safety outcome was mortality. Secondary outcomes included hospital stay, hematoma clearance rate, operative time, recurrent hemorrhage, and infection rates. Subgroup analyses were performed based on surgical intervention, hematoma type, and follow-up duration. Results: A total of 551 patients who underwent surgical treatment for spontaneous ICH were included in the analysis, based on five observational studies. Compared with the non-ICP group, patients who received ICP monitoring were associated with lower rates of unfavourable functional outcome (OR = 0.27, 95% CI 0.15–0.46) and shorter hospital stays (MD = –3.90 days, 95% CI –5.09 to –2.71). No significant differences were observed in mortality (OR = 1.24, 95% CI 0.71–2.17), haematoma clearance rate, operative time, or complication rates. Subgroup analyses further indicated that, among patients with hypertensive ICH undergoing minimally invasive surgery, the use of adjunctive ICP monitoring was associated with a lower incidence of unfavourable functional outcome without a corresponding increase in mortality. Conclusions: The use of ICP monitoring was associated with improved functional outcomes in surgically treated patients with spontaneous ICH, without an observed increase in mortality or complications. These findings suggest a potential role of ICP monitoring in postoperative management, which warrants further validation in prospective studies.